Consumers can tell it’s fall when stores start selling Halloween candy and offering flu shots. It’s also the time when Medicare advertisements flood airwaves and mailboxes. Open enrollment for Medicare, the federal health program for older people and some people with disabilities, is happening from October 15 to December 7. This is the time when enrollees can make changes to their coverage, whether they are in the traditional Medicare program or Medicare Advantage plans offered by private insurers. It’s recommended that beneficiaries take the opportunity to review their current coverage, as health and drug plans may have made changes to their networks and prescription costs. For 2024, there are new features, including a lower out-of-pocket cost limit for patients taking expensive drugs. Accessibility to preferred doctors, hospitals, and pharmacies is important to consider, as Medicare Advantage plans have specified provider networks. Traditional Medicare does not cover prescriptions, so it is wise for members to consider signing up for Part D, the optional drug benefit. On the other hand, most Medicare Advantage plans include drug coverage, but beneficiaries should verify this before enrolling. Medigap policies are available for those 65 and older who are joining traditional Medicare for the first time, covering out-of-pocket costs such as deductibles and copays. It’s important to note that switching from Medicare Advantage to traditional Medicare during open enrollment may cause issues when purchasing a Medigap policy, as private insurers can reject applicants with health conditions or limit coverage. There is a second open enrollment period from January 1 to March 31 each year, specifically for Medicare Advantage plan participants to make changes. Starting from 2024, the out-of-pocket costs for high-priced medications will have an annual cap, thanks to President Joe Biden’s Inflation Reduction Act. This cap will greatly benefit those who fall into Medicare’s “catastrophic” coverage tier. However, it’s crucial to understand that this cap does not apply to infused drugs administered at doctor’s offices. Medicare is expanding eligibility for low-income beneficiaries to qualify for low- or zero-premium drug coverage, and insurers may have made changes to drug coverage, so beneficiaries should review their plan’s formulary. Medicare’s online plan finder can help consumers compare Advantage and Part D drug plans by ZIP code. Enrollees should also confirm if their preferred doctors, hospitals, and pharmacies participate in any given Advantage plan. The State Health Insurance Assistance Program and the Medicare hotline are available for free enrollment assistance. Insurance brokers can help, but consumers should keep in mind that they may not represent all available plans. It’s recommended to avoid telemarketers who sell private plans. Open enrollment for Medicare is an important time for beneficiaries to review their coverage and make informed decisions.
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